Getting from ‘Wow’ to Sustainability

BANGKOK, Thailand—With a cellphone application, mClinica can monitor trends in prescriptions for diabetes medicines in a sample of pharmacies in Ho Chi Min City, Vietnam. With sensors connected to smokeless cook stoves, SweetSense can monitor if the communities are actually using them. With satellite sensors, Servir detects how fish swim in the Xe Kong River and identifies potential barriers that may result from the placement, design, or operation of dams.

These were among the information technologies demonstrated at the Harnessing the Data Revolution for Resilience summit, held May 11-12 in Bangkok, Thailand, and sponsored by the U.S. Agency for International Development (USAID). The summit included people, organizations, and companies working in a variety of sectors, including climate change, human trafficking, health, anti-corruption, and more. As director of the MEASURE Evaluation project, I attended to bring a health sector perspective and to listen for developments in other sectors that might have relevance for health.

It’s an exciting prospect that disparate technologies could transform health information. But governments should know that there still will be specific questions they should ask before adopting any of them.

MEASURE Evaluation, funded by USAID, works with governments of low- and middle-income countries (LMICs) to strengthen their ability to collect and use data to guide public health programs. The Bangkok summit heightened my awareness of the contrast and complementarity of data collected by the government for a health information system and data collected by others—often in the private sector.

In LMICs, cell phone technology famously leapfrogged over landline technology, and quickly connected virtually everyone in every location. Is the same true for health information systems? Are the new technologies leapfrogging the government systems that require two people to come together? The answer is no, but not entirely so.

Private companies are finding ways to collect data through technologies that now advance at lightning speed. They include cell phones, sensors that can be planted to collect information, and remote sensors such as satellites. Cell phones and sensors on the ground typically collect data on a sample of people. Satellite sensors are currently best suited for monitoring the environment in which populations live.

Alongside the agile IT innovations of private industry, the systems for collecting health data on an entire population can appear cumbersome and archaic. Health data collected by the government often require that two people come together: a person close to the experience, such as the patient or a parent or spouse, and a person collecting the information, such as a clinician or a community health worker. These data are seldom samples, and cannot be collected remotely.

The health of an individual cannot be sensed from outer space. Two people must still come together to figure out what is happening. Admittedly, new technologies do speed the process of collecting health data and aggregating it for analysis. And in some instances, information on a sample of people will provide answers that are not available in routinely collected data. But we still need individual data on everyone to ensure that all are attended to.

New IT developments can be helpful to a government health information system, but they can also pose risks. With rapid turn-over in hardware and software, they can be expensive to maintain. Moreover, the company that developed an application can fail, and support for maintenance can disappear. A government—be it local or national—must be discerning about the technologies it adopts or the data sources it chooses to embrace for guiding its health programs. It must look beyond the ‘Wow!’ factors of speed and colorful data visualization. Questions to ask include these:

What is the quality of the data?What processes are followed to ensure that the data are reliable?

Who do the data represent? If based on a sample, what are the inherent biases?

How affordable is it in the long run? What are the recurring costs for hardware and software updates, and for training and re-training those who use the system?

To what degree does using the data cause a government to be dependent on an outside source? To what degree does it enable a local or national government to be self-reliant?

What are the ethical concerns in the data and how adequately are they addressed? Are people aware that data are being collected on them? Is their permission needed?

What is the value added of the information? Is it just a high-tech way of telling you what a well-informed person could tell you just as reliably over a cup of coffee?

Is the new technology a temporary work-around to a broader system that must be fixed? Will it postpone or accelerate the fix to the root need?

Technological advances are improving health information systems, but their sheer number requires that governments select carefully among them. Asking these questions helps ensure that the ‘Wow’ factor of a new technology translates into substantial and sustainable improvement in a county’s health information system.